Dr. Michael Spangler, who has been practicing medicine for 40 years, is happy using paper records. He isn't convinced that going digital will be an improvement.

Barry Gutierrez for NPR

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Originally published on July 16, 2013 9:39 am

Uncle Sam wants your doctor to go digital. And the federal government is backing that up with money for practices that start using computerized systems for record keeping.

Nearly half of all physicians in America still rely on paper records for most patient care. Time is running out for those who do to take advantage of federal funds to make the switch. So practices like Colorado Springs Internal Medicine are scrambling to get with the program.

Nearly 200 patients come through the office on a typical day. Doctors and staff pop in and out of exam rooms and offices constantly, carrying big stacks of manila folders holding patient charts.

Behind the front desk, Dr. Jay Kinsman stands at the practice's information nerve center. "There'll be probably 500 pieces of paper come in on the fax, two times, three times a day," he saysi with a chuckle. "If that goes down we might as well close."

He is only half-joking. The office has a backup fax machine just in case.

About a year ago the practice decided it was time to go to an electronic health record system, or EHR. Kinsman took charge of shopping for the right one. He quickly felt overwhelmed.

"Do we really need 250 different EHRs, and 30 fairly widely used ones and 15 really big ones?" he asks. "Could we get by with one? Would we do better with just one product?"

Actually, there's closer to 1,000 products out there. The market exploded when the federal government started offering doctors financial incentives to buy them. The government also said that those who don't go digital will face penalties in the future.

So, all across the country, doctors like Kinsman are taking sales calls. His decision will affect not only his and his partners' days but also their incomes.

"When we were starting to think about this, we were hearing dollar figures on the order of $40,000 per physician to purchase an EHR and install it, and then lost revenue in the first two or three or four months," he says. "Basically we're planning on seeing only half as many patients a day for the first two to four weeks."

There are also decisions about computer hardware — laptops or tablets in the exam room? Host the system on their own server, or in the cloud? Hire a technolgy specialist, or outsource the job?

Vexing as all that is, the practice's business manager, Vicky Bonato, says it's probably not even their biggest challenge. "Having everybody have a positive attitude to do it. If we could all keep positive and just get through it and learn it," she says, "if we could do that I think we'll be OK."

Not every doctor in the practice is enthusiastic about switching to electronic records. Mike Spangler has been practicing medicine for 40 years. He's not convinced that going digital is going to make things better.

"It's going to take a lot of time; it's going to decrease productivity," he says. "And it's going to be very expensive. So, it means kind of three strikes against it and not as many strikes for it."

"Especially when people are finding that they bought a product and now are not happy with it," she says. "It wouldn't surprise me if there would be two or three times a replacement process before things settle down for any given practice"

The message from the federal government is much more upbeat. It says American medicine is making great progress toward reaping the benefits of the digital age. The White House says more than half of U.S. doctors are now using electronic records in a meaningful way, and the Obama administration's head of health information technology says digital records will transform the practice of medicine.

This piece is part of a reporting partnership among NPR, Colorado Public Radio and Kaiser Health News.

We begin this hour with All Tech Considered and a look at the federal government's efforts to get doctors and hospitals to digitize medical records. Nearly half of all physicians in America still rely on paper records for most patient care, this despite the government setting aside over $20 billion of stimulus funds for health care providers to buy digital record systems. Some practices could get over $60,000.

In a moment, we'll talk to the man in charge of the national effort to get doctors to go digital. But first, Colorado Public Radio's Eric Whitney spent some time at a medical practice that's trying to make that switch now. And his finding? It's not so easy.

DR. JAMES KINSMAN: There'll be probably 500 pieces of paper come in on the fax two times, three times a day.

WHITNEY: So the fax machine is like the linchpin of the whole...

KINSMAN: Yeah, exactly. If that goes down, we might as well close.

WHITNEY: Kinsman is only half-joking. They have a backup fax machine just in case. About a year ago, the practice decided it's time to go to an electronic health record system, or EHR. Kinsman took charge of shopping for the right one and quickly felt overwhelmed.

KINSMAN: Do we really need 250 different EHRs and 30 fairly widely used ones and 15 really big ones? Could we get by with one? Would we do better with just one product?

WHITNEY: Actually, there's far more than 250 EHR products out there - closer to a thousand. The market exploded when the federal government started offering doctors incentive payments to buy them. The government also said those who don't go digital will face payment penalties in the future. So all across the country, doctors like Kinsman are doing what he's doing today: spending his lunch break meeting with a software salesman.

UNIDENTIFIED MAN: Here's patient's name. You can see their address with their insurance and copay. And we're going to come down here and really select the reason why they're coming in. This is what they're telling the front office they're coming in for...

WHITNEY: Kinsman is putting a lot of hours into choosing the right software. His decision will directly impact not only he and his partners' everyday work, but also everyone's incomes.

KINSMAN: When we were starting to think about this, we were hearing dollar figures on the order of $40,000 per physician to purchase an EHR and install it, and then lost revenue in the first two or three or four months. Basically, we're planning on seeing only half as many patients a day for the first two to four weeks.

WHITNEY: There are also decisions about computer hardware. Laptops or tablets in the exam room? Host the system on their own server or in the cloud? Hire an IT specialist or outsource it? Vexing as all that is, the practice's business manager, Vicky Bonato, says it's probably not even their biggest challenge.

VICKY BONATO: Having everybody have a positive attitude to do it. If we could all keep a positive attitude and just get through it and learn it. If we could do that I think we'll be OK.

WHITNEY: Not every doctor in the practice is equally enthusiastic about switching to electronic records. Mike Spangler, who has 40 years experience in medicine, says the paper record system the practice has always used actually works just fine. He's not convinced that going digital is going to improve things.

DR. MICHAEL SPANGLER: It's going to take a lot of time, it's going to decrease productivity and it's going to be very expensive. So it means kind of three strikes against it and not as many strikes for it.

WHITNEY: Spangler isn't just griping. Margaret A., a consultant who's written about how to switch from paper to digital health records, says the experience is leaving a lot of doctors frustrated.

MARGRET AMATAYAKUL: And especially when people are finding that they bought a product and now are not happy with it, it wouldn't surprise me if there would be two or three times a replacement process before things settle down for any given practice.

WHITNEY: The message from the federal government is much more upbeat. It says American medicine is making great progress toward reaping the benefits of the digital age. The White House is pleased that more than half of U.S. doctors are now following the government's recommendations. For NPR News, I'm Eric Whitney in Colorado Springs.

CORNISH: This piece is part of a partnership with NPR, Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.